Restricted Audiology Services: North Staffs cuts hearing aid provision

In a move that has been slammed by professionals, charities and hearing aid users, North Staffordshire Clinical Commissioning Group (CCG) has decided to stop providing hearing aids to people with mild hearing loss and restrict supply to those with moderate losses.

After months of consultation and several delays on the final decision, North Staffs Clinical Commissioning Group announced on 4th March that the trust will be cutting the number of hearing aids provided to people in the North Staffordshire area. Audiologists at Newcastle-under-Lyme and Staffordshire Moorlands hospitals will no longer be able to provide hearing aids to people with mild hearing loss and they will have to make people with moderate hearing loss go through an eligibility test to see if they should receive them.

The initial proposal had also threatened to completely end the service for sufferers with ‘moderate’ hearing loss, which would have hit 2,500 people, but saved £1.2 million a year. But under an amended plan only those diagnosed with ‘mild’ deafness will now miss out, although people in the moderate category will have to go through additional hurdles to try to get a hearing aid. The proposal has been pushed through despite opposition from members of the health select committee at Staffordshire County Council who voted in September 2014 to oppose the plans, and asked the CCG to reconsider its proposals.

Action on Hearing Loss has condemned the decision, which was delayed for seven months due to growing opposition to the proposal. Paul Breckell, Chief Executive for the charity has said, “We are deeply opposed to North Staffordshire CCG’s decision to deny people with mild hearing loss the hearing aids they need, and force people with moderate hearing loss to go through an unnecessary and inappropriate eligibility test.

“The CCG’s position that there is not enough evidence to support hearing aid provision for people with mild to moderate hearing loss is inaccurate ― hearing aids are the only viable, most cost effective treatment for hearing loss and a lifeline to millions of people.

“There has been a lack of discussion around what is a clear and robust evidence base and to spend only ten minutes coming to a final decision is an insult to the people of North Staffordshire and professional who work in NHS Audiology.”

Short-term gain with a long-term impact

Research has consistently shown that people with hearing loss can become socially isolated, suffer from depression, lose their jobs and it can have a huge impact on family life. Two independent reports published in 2014 showed the financial burden on society of untreated hearing loss ―costing the UK upto £30 billion per year in potential economic output. The Commission on Hearing Loss published by ILC-UK stated that, ‘Politicians can no longer afford to ignore the individual, economic and social cost of hearing loss.’

In the report, many expert witnesses argued that it was important for CCGs to take a long term outcomes-based approach to the commissioning of services – to think about what the commissioning decisions mean for patient wellbeing and not just the costs of the individual processes involved. It was also argued that failure to take a long-term approach could lead to inefficiencies and ultimately more costs borne by the NHS.

An article in The Guardian national newspaper by Jackie Ashley said, “Austerity economics across the NHS may save money now, but it causes real hardship and the costs will be felt for years to come.” She wrote, “There is now a formidable body of research showing that hearing loss has a huge impact on other health problems including frequent falls, depression, Alzheimer’s and even sight loss. For obvious reasons, for many people it can also mean the loss of their jobs…figures show that more than a third of the Access to Work budget in England and Wales was spent on people with hearing loss, costing more than £31m.

“But that doesn’t begin to cover the true costs – the medical intervention needed for depressed, isolated and vulnerable people who pay more visits to their GP and who often end up in A&E. For many people, hearing loss is the beginning of a downward spiral which ends in hospital or full-time care.”

Despite the volume of evidence and vociferous opposition, North Staffordshire CCG has made its decision. A spokesperson from the CCG said, “It is important to recognise that we carried out an extensive engagement exercise with the public and patients last year where we received feedback from over 2,000 individuals. We are truly grateful for this feedback as it has helped to shape our thinking. As a result of this feedback, and in conjunction with audiology and public health professionals, we can confirm that we will be recommending the funding of hearing aids for those with moderate or greater hearing loss.

“The approval of hearing aid provision will be based on an audiology assessment of moderate hearing loss of 41-55 decibels and a functional impact assessment to determine the impact of hearing loss on an individuals' daily life. A hearing loss of 56 decibels and above is not affected by this policy. “We have created a policy that seeks to ensure that hearing aids are prescribed appropriately for those individuals who absolutely need hearing aids and who have had an audiology assessment of moderate hearing loss of 41-55 decibels, or more, and a functional impact assessment to determine the impact of hearing loss on an individuals’ daily life.

Children will not be affected

The proposed policy will not affect children or patients with a hearing loss since childhood. It also will not affect those with dementia, a learning disability, tinnitus, sudden onset hearing loss, multiple physical or sensory disabilities or auditory processing problems.

Speaking to The Sentinel newspaper, CCG chairman Dr Mark Shapley - a Wolstanton GP - claimed 40 percent of hearing aids issued on the NHS were never used. He said: "As GPs we feel obliged to refer people for audiology tests even though we know this many aids go unused. "This issue is not about just hearing aids - it is to ensure our resources are fairly used throughout the population for all illnesses." The Sentinel article concludes, ‘The change means from October those with "mild" hearing loss, scored at less than 41 decibels by specialists, will be sent back to their GPs. They will be advised of the option to pay for private aids and then thrown off NHS waiting lists.

Victoria Adshead, editor in chief of Audio Infos United Kingdom, Photos: iStock / NLshop